If I failed ETT x3, got a supraglottic that was ventilating, and was transferring from one of my rural centers, I would not likely attempt ETT again and the fact that I already failed three times is clear documentation.
Caveat: I’m a resident, would love to be corrected if I’m off base here.
While it’s a lot better than nothing, I’m not sure that supraglotic airway was doing much. Admittedly it got her rosc but from skimming the documentation her peak o2 sat was 82% with the king in place. When she arrived after transport her saturation was allegedly reading at 40%. The limited history she gave the rural doc was basically “I don’t have obstructive airway disease, I’ve never smoked, never had asthma or copd.” She then suffered what sounds like hypoxic respiratory failure, apnea and cardiac arrest.
Presumably he was giving lopressor (wtf?) because he thought the patient was in flash pulmonary edema and wanted to reduce afterload (or to make sure there was one less witness to this whole debacle by killing her remaining inotropy).
It seems like having some more effective positive pressure in the system would have been a good idea both for the hypoxia and the need to reduce her preload.
While I agree his 4th attempt to intubate was probably not what was going to save her, calling a flight crew in (who has drugs to rsi, and maybe is a little better at intubating) ASAP might have helped her.
I don’t think the receiving doc committed malpractice.
The combo of blind nasotracheal intubation in hallway, 3xfailed intubation, questionable supraglotic airway placement, and bb this patient seem way closer to malpractice to me, though it seems murky. She certainly did not seem optimally prepared for transport
